As DN has told the prosecutor has decided to close down the investigation of serious involuntary manslaughter in the five cases, which concerned cancerköerna at the Karolinska in the summer of 2017, and affected patients with cancer of the liver and pancreas, the pancreas. Prosecutor Jennie Nordin concludes that there has been a greater risk for patients to undergo surgery at Danderyd hospital, than to wait on the surgery at the Karolinska. All five patients included in the investigation, which was Bertil Gustafsson, was operated on too late and is now dead.
the chief Physician Lars Granström was the contact person at Danderyd hospital during the summer weeks when the hospital, in an e-mail had offered to operate in the Karolinskas queue, an offer that was not taken by the Karolinska. Granström is critical to the conclusion that there had been a larger risk for the patients to undergo surgery at Danderyd hospital, several years ago, does not carry out big operations in the pancreas, but where the operation could be done without delay. Of the e-mail is also apparent that several types of interventions proposed.
– Believe the prosecutor – and others – that we offered to help, but to be able to cope with the operations that were current. It is completely preposterous, " says Lars Granström.
when the doctors at Danderyd noticed how the queues grew, refers to the head of Danderyd hospital, even to a scientific article from the Karolinska, which shows the relationship between the anticipation of the surgery and the results of the pancreasoperationer.
– If you wait long by the pancreas carcinoma you know that the man dies in his illness, and the risk must, of course, and with a prosecutor, to understand is greater than to undergo surgery at a different hospital, by the surgeons who can perform the surgeries they promised to help with, " says Granström.
The acting department head in the gastro centre at the Karolinska in Huddinge, who finished mejlkonversationen, and in practice, was the one who said no to the help, have not been consulted. Köproblemen was denied also by the hospital management as healthcare administration asked. In the investigation warns former master kai fa Melvin Samsom in June 2017 internally in an email that the administration would hear.
an anonymous tip from gastro if 50 patients with pancreas cancer will end up in the queue. Barbro (Naroskyin, health and sjukvårdsdirektören ed) will be told by itself”, is called it in the email.
According to Jennie Nordin, it is not possible to prove ”it, or those who were suspected” guilty of the crime. She has explained in an email to DN in the pre-trial investigation looked broadly at the course of events, and not focused on a single designated person. The deadline of the so-called standardized vårdförloppen are only recommendations, and according to the prosecutor, no one can be held criminally responsible for the operation is not done in time.
In Stockholm county surgery pancreas carcinoma just at the Karolinska in Huddinge. Lars Granström has together with colleagues had turned against what they call a ”zero to death”, then they pointed out that the concentration of the highly specialised interventions through the so-called nivåstrukturering, and on the other leads to increased waiting times, but also depletes the smaller hospitals on the skills.
performed surgeries of the pancreas carcinoma only on the country's teaching hospitals, including Karolinska Huddinge is one, and at the central hospital in Karlstad, which perform 50 pancreasoperationer of the year. By an agreement also sends Academic university hospital in Uppsala, patients can avoid long waiting times.
Kristiina Kask, head of the area of activity of surgery at the university says that the pancreas carcinoma surgery in Karlstad in individual cases.
– It is the nivåstrukturering applicable, but in some cases they have been able to help during the periods when we see that the waiting time increases.
" No, you can absolutely not say. Waiting for you for a long time, so the waiting time is a risk. One turns to someone else so you know that they pass the invasiveness of the surgery and have the entire care chain. We know that Karlstad hold the standard, " says Kristiina Kask.
Mikael Bergenheim, pancreaskirurg and operations manager of the surgeon in Karlstad, sweden, says that centralsjukhusets role is unique in Sweden, through the regional responsibility for pancreasoperationer which you share with Academic. All patients previously underwent surgery at the university hospital in Örebro, sweden, sent two years ago, back to Karlstad, partly to reach a larger number of operations. All patients are discussed at a regional conference in conjunction with the Academic.
" We have a long history of carrying out these pancreasoperationer. We have good results, and in addition, both education and research.
means that Karlstad can relieve the pressure on the queue.
– At the temporary accumulations in Uppsala so we can offer surgery. It is demanding and difficult operations, requiring careful planning, and therefore not so easy to handle temporary peaks.
Bergenheim says that time is a crucial factor for pancreas carcinoma should go to surgery.
" We know that time is important, but not how important. We have an ongoing study that investigates just this.
According to the so-called standardized vårdförloppen to pancreas carcinoma operated on within 36 days after the established diagnosis. In the summer of 2017 could the waiting time at the Karolinska become twice as long. Bertil Gustafsson underwent surgery after ten weeks.
have advantages compared to the university hospitals says Bergenheim that there may be greater scope for flexibility. In Karlstad is a day of the week, earmarked for the pancreasoperationer.
– There are logistical benefits of a small hospital, with shorter decision paths. When a patient comes remitterad from Örebro and Uppsala, we can receive with very little advance notice. I can with a few steps in the corridor to meet with all involved so that we can get to the surgery.